“I just don’t want us to make the mistake of not having the legal text,” she added. ‘Let’s do them both together. Let’s do it right. Let’s make sure there are no misunderstandings, because there have been too many misunderstandings.”
Democrats are uniting around a measure that would expand monthly tax credits to families with children, create a federally guaranteed pre-kindergarten program, and expand financial support for childcare, home health care, and employee training and housing. But a number of provisions remain in flux, including a push to expand Medicare to include dental, vision and hearing benefits, a priority for Mr. Sanders and other liberals.
As it stands, passing the bill, which is also expected to include about $500 billion in climate and environmental utilities, could technically deliver on Mr. Biden’s ambitious pledge to cut U.S. emissions, although there are many potential obstacles would remain, according to an analysis by Rhodium. Group, an independent policy research agency. Those provisions would include about $300 billion in tax incentives to promote renewable energy and electric vehicles.
Lawmakers have also scaled back their ambitions to provide health coverage to poor adults whose states have chosen not to expand Medicaid, and are considering a more temporary solution. As negotiations continue, several people familiar with the discussions said the package could include three years of funding for poor residents of those states to get federal assistance in purchasing health plans under the Affordable Care Act.
The plans would in fact be free and would come with grants to lower deductibles and other forms of cost-sharing. An estimated 2.1 million poor Americans are uninsured in those states, mostly in the South, and insuring it has been a top priority for lawmakers such as Representative James E. Clyburn of South Carolina, the No. 3 House Democrat and Senators Raphael Warnock and Jon Ossoff of Georgia. It has also been a priority for Ms Pelosi, who sees the measure as key to strengthening the framework of the Affordable Care Act.
The compromise has disappointed some lawmakers and advocates who had hoped for a permanent extension of coverage — and for those who believed a federal Medicaid program would provide better safeguards for low-income patients than health-sharing plans.
Reporting contributed by Jonathan Weisman, Margot Sanger-Katz, Coral Davenport and Catie Edmondson.